Lithium Disilicate Glass-ceramics Research Articles

Long-Term Bonding Efficacy of CAD/CAM Hybrid Restorative Materials and Universal Adhesives.

In-office and lab milled prostheses are the staple for indirect restorations. It is therefore critical to determine their long-term bonding durability. CAD/ CAM blocks of two classes of restorative materials: 1) a nano-ceramic reinforced polymer matrix (NCPM) and, 2) a polymer-infiltrated ceramic network (PICN) were bonded using four different universal adhesives (UA) and silane systems. A lithium disilicate glassceramic (LDS) was used as a reference. The blocks were bisected and bonded with different UA/resin-cement pairs. Bonded blocks were then cut into 1.0x1.0x12.0 mm bar specimens for microtensile bond testing. Half the bars were subjected to bond strength testing immediately and the other half after aging by 50,000 thermal cycles between 5°C and 55°C. ANOVA and post-hoc tests were used to compare mean bond strength among groups. NCPM presented consistently high bond strength regardless of bonding techniques, while the bond strength of PICN and LDS were lower when bonded with UA relative to traditional silanes. The more hydrophilic UA produced higher bond strengths. Glass-ceramics exhibited lower bond strength with UA than the conventional etch-rinse-silane techniques. However, UAs preserved bonding interface in the long-term. NCPM displayed superior bond strength relative to PICN and LDS regardless of the type of adhesives and bonding techniques.

Fracture resistance of CAD/CAM endocrowns made from different materials in maxillary premolar interproximal defects.

This in vitro study aims to compare the fracture resistance of three CAD/CAM materials used in endocrown restoration of interproximal defects in maxillary premolars. 45 maxillary premolars extracted as part of orthodontic treatment were included. Following standardized root canal treatment, all teeth were prepared into Mesial-Occlusal (MO) cavity types. The samples were then randomly divided into three groups: LD [repaired with lithium disilicate glass ceramics (IPS e.max CAD)], VE [treated with polymer-infiltrated ceramics (Vita Enamic)], and LU [repaired with resin-based nanoceramics (Lava Ultimate)]. Axial static loading was applied using a universal testing machine at 1mm/min until fracture, and fracture resistance and failure modes were recorded. Regarding Fracture Resistance Values (FRVs), the LD group exhibited significantly higher values than the other two groups, VE (P = 0.028) and LU (P = 0.005), which showed no significant difference (P = 0.778). On the other hand, regarding failure modes, the LD group had a higher prevalence of irreparable fractures compared to the other two groups, VE (P < 0.001) and LU (P < 0.001), which showed no significant difference. Although lithium disilicate glass ceramics exhibited higher FRVs, they had a lower repair probability. In contrast, polymer-infiltrated ceramics and resin-based nanoceramics contributed to tooth structure preservation. For maxillary premolars with interproximal defects following root canal treatment, resin ceramic composites are recommended for restoration to enhance abutment teeth protection.

Occlusal veneers and load-bearing capacity of a restored tooth.

The aim of this study was to evaluate the influence of restoration bonding and type of preparation on load bearing capacity of a tooth restored with indirect glass ceramic or hybrid ceramic occlusal veneer restoration. Occlusal surfaces of extracted human molar teeth were prepared for indirect occlusal veneers with or without circumferential chamfer. The occlusal veneers were milled either from CAD/CAM hybrid ceramic (HC) Cerasmart (GC), or lithium-disilicate glass ceramic (LDGC) IPS e.max CAD (Ivoclar Vivadent) blocks. Finalized veneers were bonded to teeth following manufacturers' instructions or according to the technique for the intended deteriorated bonding using n-hexane wax solution preconditioning on restorations (n=8/group). The ultimate fracture load was recorded, and fracture types were analyzed and classified visually. Statistical analysis was performed using one-way ANOVA. The highest fracture load was recorded in teeth with bonded LDGC veneer (p≤0.0007). The bonded HC veneers had only marginally higher fracture load compared to non-bonded veneers. In all groups with deteriorated bonding, veneers loosened without tooth fracture whereas in the bonded veneer groups tooth fractures were observed, especially in teeth restored with LDGC material. Bonded LDGC occlusal veneers have high load bearing capacity which exceeds the fracture resistance of tooth structure. Circumferential chamfer preparation for an occlusal veneer has no influence on fracture load of a restored tooth.

Pressureless sintered lithium disilicate glass-ceramics: Influence of particle size and crystallization state

The pressureless sintering process is essential to densify near net shaped parts with good shape fidelity. In this work, the impact of the particle size distribution and crystallization state on the processing and properties of final sintered multicomponent lithium disilicate (SiO2-Li2O-K2O-P2O5-Al2O3-ZnO) was evaluated. Higher densification was achieved by pressureless sintering at lower temperatures for samples prepared with fine glass-based powders (825 °C; ≈96%) rather than coarse crystallized powders (975 °C; 92.9%). However, samples based on fine powders presented a microstructure characterized by low aspect ratio crystals, while those based on coarse powders presented needle-like crystals with high aspect ratio. Best mechanical properties were found in samples prepared with coarse glass powders (relative density≈ 95.1%; Vickers Hardness≈ 5.2 GPa; indentation fracture toughness≈ 2 MPam0.5; flexural strength≈ 317 MPa) sintered at 875 °C-1 h. These results can provide valuable orientations for the post-processing of lithium disilicate glass-ceramics prepared by additive manufacturing techniques.

Biosafety and chemical solubility studies of multiscale crystal-reinforced lithium disilicate glass-ceramics.

Lithium disilicate (Li2 Si2 O5 ) glass-ceramics are currently a more widely used all-ceramic restorative material due to their good mechanical properties and excellent aesthetic properties. However, they have a series of problems such as high brittleness and low fracture toughness, which has become the main bottleneck restricting its development. Therefore, in order to compensate for these shortcomings, we propose to prepare a reinforced glass-ceramics with better mechanical properties and to test the biosafety and chemical solubility of the material. Li2 Si2 O5 whiskers were synthesized by a one-step hydrothermal method, and multi-scale crystal-enhanced Li2 Si2 O5 glass-ceramics were prepared by reaction sintering. The biosafety of multi-scale crystal-reinforced Li2 Si2 O5 glass-ceramics was investigated by in vitro cytotoxicity test, rabbit pyrogen test, mice bone marrow micronucleus test, skin sensitization test, sub-chronic systemic toxicity test, and chronic systemic toxicity test. Additionally, the chemical solubility of multi-scale crystal-reinforced Li2 Si2 O5 glass-ceramics was investigated. The test results showed that the material was non-cytotoxic, non-thermogenic, non-mutagenic, non-sensitizing, and non-systemic. The chemical solubility, determined to be 377 ± 245 μg/cm2 , complied with the ISO 6872 standard for the maximum solubility of ceramic materials. Multi-scale crystal-reinforced Li2 Si2 O5 glass-ceramics' biosafety and chemical solubility met current normative criteria, and they can move on to mechanical property measurements (such as flexural strength test, fatigue life test, friction and wear property study, etc.) and bonding property optimization, which shows promise for future clinical applications.

Preparation of Li2Si2O5 fibers and their toughening effects on lithium disilicate glass-ceramics

To address the challenge of poor fracture toughness of lithium disilicate glass-ceramics, which hinders their application as posterior single crowns and three-unit fixed bridges, the concept of fiber toughening was employed. In this study, Li2Si2O5 fibers were successfully prepared through an electrospinning technology combined with sol-gel followed by a heat treatment. The fibers could be further densified by adding SiO2 nano-powder to partially replace TEOS as a silicon source and the possible mechanism was put forward. By using the fibers as the reinforcement phase, the uniform fiber-toughened Li2Si2O5 glass-ceramic composites were successfully produced by hot pressing sintering. These composites exhibited significant enhancements in mechanical properties, including a flexural strength of 315 ± 10 MPa, fracture toughness of 4.57 ± 0.35 MPa m1/2, and Vickers hardness of 5.61 ± 0.28 GPa, respectively. Notably, the highest fracture toughness of the composite increased by 41 % compared to the samples without fiber reinforcement, which was attributed to the toughening mechanisms including crack deflection, fiber bridging, and fiber pull-out. The results demonstrated the advantages of Li2Si2O5 fibers in toughening glass-ceramic materials, thereby expanding the application areas of this material.

Porous Lithium Disilicate Glass-Ceramics Prepared by Cold Sintering Process Associated with Post-Annealing Technique.

Using melt-derived LD glass powders and 5-20 M NaOH solutions, porous lithium disilicate (Li2Si2O5, LD) glass-ceramics were prepared by the cold sintering process (CSP) associated with the post-annealing technique. In this novel technique, H2O vapor originating from condensation reactions between residual Si-OH groups in cold-sintered LD glasses played the role of a foaming agent. With the increasing concentration of NaOH solutions, many more residual Si-OH groups appeared, and then rising trends in number as well as size were found for spherical pores formed in the resultant porous LD glass-ceramics. Correspondingly, the total porosities and average pore sizes varied from 25.6 ± 1.3% to 48.6 ± 1.9% and from 1.89 ± 0.68 μm to 13.40 ± 10.27 μm, respectively. Meanwhile, both the volume fractions and average aspect ratios of precipitated LD crystals within their pore walls presented progressively increasing tendencies, ranging from 55.75% to 76.85% and from 4.18 to 6.53, respectively. Young's modulus and the hardness of pore walls for resultant porous LD glass-ceramics presented remarkable enhancement from 56.9 ± 2.5 GPa to 79.1 ± 2.1 GPa and from 4.6 ± 0.9 GPa to 8.1 ± 0.8 GPa, whereas their biaxial flexural strengths dropped from 152.0 ± 6.8 MPa to 77.4 ± 5.4 MPa. Using H2O vapor as a foaming agent, this work reveals that CSP associated with the post-annealing technique is a feasible and eco-friendly methodology by which to prepare porous glass-ceramics.

Effect of Artificial Aging on Translucency of Zirconia Reinforced Lithium Silicate and Lithium Disilicate Ceramics: A Systematic Review.

Digital dentistry and advanced ceramic materials have been widely used but which material has a better esthetically durable outcome needs to be evaluated. The purpose of this systematic review and meta-analysis was to evaluate the difference in the translucency of CAD zirconia-reinforced lithium silicate and CAD lithium disilicate glass ceramics after being subjected to artificial aging. Two independent reviewers searched the MEDLINE/ PubMed, Embase, and EBSCO databases and the Google Scholar search engine for in-vitro studies published from January 2010 to May 2023 to identify relevant studies measuring the translucency of CAD ZLS and CAD lithium disilicate glass ceramics after being subjected to different artificial aging conditions using the coffee solution, 4% acetic acid, distilled water and UV aging. For qualitative synthesis, 10 studies were included. A statistically significant difference was observed between CAD zirconia-reinforced lithium silicate and CAD lithium disilicate glass ceramics (P⟨0.05, mean difference=-0.25 [-0.38,-0.11]). Translucency of CAD ZLS was less than CAD lithium disilicate glass ceramics. Artificial aging has decreased the translucency of glass ceramics. For fixed prosthetic rehabilitation clinicians can opt for CAD lithium disilicate glass-ceramic as a more esthetically pleasing and durable material in oral environment.

Electrochemical behavior and degradation mechanism of lithium disilicate glass ceramics in acidic environment

AbstractIPS e.max Press, a lithium disilicate‐based glass ceramic, is renowned in dental restorations for its mechanical strength and aesthetic appeal. This study delves into its behavior within oral environments, employing electrochemical and surface analysis techniques. By utilizing cyclic polarization curves and impedance spectroscopy, we evaluated its degradation resistance. Surface morphology, composition, and crystal stability were explored through scanning electron microscopy (SEM)/energy‐dispersive X‐ray spectroscopy (EDX) and X‐ray powder diffraction (XRD) analysis. The glass ceramic exhibited robust resistance to localized degradation across all tested electrolytes. The degradation potential (Ecorr) varied with time and pH, indicating electrolyte influence. SEM/EDX affirmed oxide layer formation, while XRD confirmed a stable structure. While showcasing favorable resistance in saliva, citric acid, and lactic acid, IPS e.max Press demonstrated susceptibility to acetic acid. This comprehensive analysis enhances our understanding, providing valuable insights for the development of durable dental materials through a combination of electrochemical analysis and surface characterization.

Complex shapes of lithium disilicate glass-ceramics developed by material extrusion

The fabrication of high-end ceramics by additive manufacturing gained increasing research interest due to the capacity of these techniques to break through the limitations of traditional extractive manufacturing. Although efficient strategies for the processing of ceramic materials by additive manufacturing have been shown, with notable examples in the dental field, the processing of dense glass-ceramics by the same means is almost unexplored. Herein, a processing strategy for the manufacture of complex shapes of lithium disilicate glass-ceramics by material extrusion is detailed shown for the first time. An aging behaviour was observed on the glass loaded aqueous suspensions and in-deep studied, being related with the leaching of Li+ ions. Based on this, a hydrogel-based ink with high solid content (ϕ≈ 50 vol%), suitable rheological properties (G´≈106 and τ ≈ 1500 Pa) and recovery time was developed. By using the optimized ink, a propeller component with high aspect ratio and small internal connected channels, as well as a dental crown were successfully printed. A debinding schedule was tuned by the combination of differential thermal analysis and hot stage microscopy. The sintered lithium disilicate glass-ceramic parts presented good relative density (≈ 96.7 ± 0.8%) and translucency. Outstanding mechanical properties were achieved (Hv ≈5.3 GPa, KIf ≈2.1 MPa.m0.5, σ ≈ 279 ± 44 MPa), comparable to values usually attained for these materials by powder technology. The low deviation of the flexural strength data reported here is related with the absence of meaningful processing defects on the analysed fracture surfaces and the homogeneous distribution of the residual porosity as microporous, resulting in a good Weibull characteristic strength σ0 = 301 MPa. The results of the present work emphasized the potential of Direct ink Writing, a material extrusion technique, to fabricate lithium disilicate glass-ceramic parts with complex geometries, as dental crowns.

Electrical properties of Lithium silicate-based glasses and their Glass-ceramics

Crystallization of lithium di- and meta-silicates were developed in the SiO2–Li2O–TiO2 glass system. Inclusion of TiO2 relatively reduced the crystallization temperature. Through the sintering process at 650 °C/2 h, lithium disilicate was devolved in the TiO2-free sample, whereas the incorporation of TiO2 catalyzed the appearance of lithium metasilicate phases. The microstructure of lithium disilicate glass-ceramics was studied using differential thermal analysis (DTA), powder X-ray diffraction (PXRD), and scanning electron microscopy (SEM). At 650 °C/2 h, the microstructure consists of spherulitic growths with reasonably sorted nanosize particles in a glassy groundmass. The electrical characteristics of lithium silicate glasses and glass-ceramics having variable concentrations of TiO2 were tested in order to explore their electronic hopping process. To clarify the effects of composition and sintering on the electrical and dielectric behavior of glasses based on lithium silicate, a Broadband Dielectric Spectroscopy (BDS) was employed. While the matching-sintered glass-ceramic exhibits like an insulator with interfacial polarization that significantly lowers the density number of free ions, bulk glass nevertheless demonstrate high conductivity. Lithium oxide considerably increases the conductivity of the composite instead of titanium oxide.

Is adhesive bonding with high and low viscosity cements able to revert the negative effect of machining on the fatigue behavior of lithium disilicate glass-ceramic?

The aim of this study was to evaluate the fatigue behavior of adhesively cemented machined and polished lithium disilicate discs and compare the influence of the resin cement viscosity used to bond the ceramics to dentin analog substrate. Disc-shaped specimens (n = 15, Ø = 12 mm; thickness = 1.3 mm) of CAD-CAM lithium disilicate (IPS e.max CAD, Ivoclar Vivadent) were prepared and divided according to processing and surface finishing (machining (M) – CEREC inLab; and polishing (P) – control) and cement viscosity (high (H) and low (L)). The specimens were treated with self-etching primer and adhesively cemented (Variolink N Base + High or Low viscosity catalyst, Ivoclar Vivadent) to dentin analog discs (Ø = 12 mm; thickness = 2.2 mm). The cemented assemblies were subjected to fatigue testing using a step-stress approach (500−1500 N; step-size of 100 N; 10,000 cycles per step; 20 Hz). Weibull statistics were conducted on fatigue data (95 % CI). Fractographic and topographic analyzes were also performed on a scanning electron microscope (SEM). Considering the same viscosity, machined groups presented statistically lower characteristic fatigue failure load (N) (FFL0 MH 1192 [1111–1278]; ML 1105 [1077–1134]) than their polished controls (FFL0 PH 1350 [1279–1424]; PL 1333 [1276–1392]). No differences were found between cement viscosities, regardless of surface characteristic. It is well known that CAD-CAM machining impairs mechanical performance of lithium disilicate glass-ceramics. Adhesive cementation was not able to revert this negative impact, regardless of cement viscosity. Cement viscosity did not affect the fatigue results.

Characteristic fatigue strength and reliability of dental glass-ceramics: Effect of distinct surface treatments – Hydrofluoric acid etching and silane treatment vs one-step self-etching ceramic primer

The aim of this study was to mechanically characterize through flexural fatigue test two CAD-CAM glass-ceramics according to distinct surface etching protocols. To do so, feldspathic (FELD) and lithium disilicate (LD) glass ceramics were subjected to different surface treatments: (1) control – no treatment (Ctrl); (2) conventional protocol etching with 5% hydrofluoric acid followed by silane coupling agent application (HF + SIL; Monobond N, Ivoclar); or (3) using a self-etching ceramic primer (E&P; Monobond Etch & Prime, Ivoclar). Ceramic discs (N = 120; Ø = 12 mm; thickness = 1.2 mm) were produced from CAD-CAM blocks, with 60 being from FELD (VITABLOCS Mark II, Vita Zahnfabrik) and 60 from LD (IPS e.max CAD, Ivoclar). Next, 20 disks of each ceramic were allocated into three groups: Ctrl, HF + SIL, or E&P. Surface roughness data were collected on all samples before and after surface treatments (except for Ctrl). Cyclic fatigue (n = 15) biaxial flexural strength tests were performed by the piston-on-three-balls geometry (ISO 6872) considering the test parameters established from a monotonic test (n = 5). The monotonic test was carried out at a 1 mm/min loading rate and 500 kgf loading cell until fracture to obtain the failure data. The cyclic fatigue test was executed underwater at a frequency up to 20 Hz, with the first stress being 25% of the monotonic test for 5000 cycles, followed by increments of 5% of the monotonic test at each step of 10,000 cycles until failure (fracture). Complementary fractography, topography and Atomic Force Microscopy (AFM) analyses were performed. Characteristic Fatigue Strength (CFS) and Weibull modulus were analyzed by Weibull analysis using the fatigue test data. Roughness and complementary analysis data were analyzed by one-way ANOVA. The statistical results exhibited similar CFS among Ctrl, HF + SIL and E&P for both glass-ceramics. The survival analysis corroborates the findings, however the Weibull modulus pointed out superior structural reliability of FELD treated with the E&P group compared to HF + SIL. According to the complementary analyses, HF + SIL exhibited a higher surface area than E&P and Ctrl for FELD (p = 0.001). Roughness showed statistically significant differences among conditions for FELD (E&P < Ctrl = HF + SIL; p < 0.05) and no difference for LD (p > 0.05). Therefore, the CFS were not influenced by any condition evaluated for FELD and LD glass-ceramics; however, superior structural reliability (higher Weibull modulus) for the feldspathic ceramic treated with the E&P was observed.

Adhesive Performance of Resin Cement to Glass-Ceramic and Polymer-Based Ceramic CAD/CAM Materials after Applying Self-Etching Ceramic Primer or Different Surface Treatments.

Ensuring optimum bond strength during cementation is vital for restoration success, with the practicality of the process being crucial in clinical practice. This study analyzed the effect of a single-step self-etching ceramic primer (MEP) and various surface treatments on the microshear bond strength (µSBS) between resin cement and glass-ceramic or polymer-based ceramic CAD/CAM materials. Specimens were fabricated from leucite-based glass-ceramic (LEU), lithium disilicate glass-ceramic (LDC), resin nanoceramic (RNC), and polymer infiltrated ceramic network (PICN) (n = 160). They were then classified based on the surface treatments (n = 10): control (no treatment); sandblasting with Al2O3 (AL); etching with hydrofluoric acid (HF); and MEP application. Scanning electron microscopy was used to evaluate the surface topography. µSBS was measured after cementation and thermocycling procedures. Failure modes were examined with a stereomicroscope. Statistical analysis involved two-way analysis of variance and Tukey HSD tests with a significance level of 0.05. µSBS was significantly influenced by both surface treatment and CAD/CAM material type. The most enhanced µSBS values for each material, regarding the surface treatment, were: LEU and LDC, HF; RNC, AL; PICN, AL or HF. MEP significantly increased the µSBS values of CAD/CAM materials except RNC, yet it did not yield the highest µSBS values for any of them.

Synergistic effect of ion release and micromorphology on biomineralization, cytocompatibility and osteogenesis of Li+/Na+ exchanged LD glass-ceramic in vitro

Lithium disilicate (LD) glass-ceramics have adequate mechanical properties and are considered as a candidate for repairing large bone defects. However, LD glass-ceramic is an inherently inert restorative material, which cannot induce new bone tissue. In the present study, LD glass-ceramics were ion-exchanged at 235 °C for 16 h, 64 h and 128 h in a mixed salt bath of sodium nitrate and potassium nitrate (1:1 M ratio) respectively. A gradient concentration distribution of Na+-rich layer was obtained by Li+/Na+ exchange and Na+ ions were released from the Li+/Na+ exchanged LD glass-ceramics in an aqueous condition. The hydroxyapatite (HA) layer was formed on Li+/Na+ exchanged LD glass-ceramic and exhibited a significant exchange time-dependent after soaking in the simulated body fluid (SBF). Moreover, the Li+/Na+ exchange treatment could improve cell adhesion, proliferation and osteogenic differentiation of LD glass-ceramic significantly, and long-time treatment could achieve a better performance. Therefore, ion-exchange process is a feasible strategy to promote the surface biomineralization, cytocompatibility and osteogenesis of LD glass-ceramics. These results suggest that Li+/Na+ exchange is a promising process for LD glass-ceramic application in clinical orthopedic reconstruction.

Atmospheric plasma treatment: an alternative of HF etching in lithium disilicate glass-ceramic cementation.

Objectives: This study aimed to investigate whether the atmospheric pressure plasma jet (APPJ) could modify the surface of lithium disilicate glass ceramics (LDC) instead of hydrofluoric acid (HF) in LDC resin cementation. Methods: Two hundred and thirty-two LDC blocks were randomly divided into seven groups: Group 1 (16 specimens) was the blank control group (without HF or APPJ treatment); Group 2 (36 specimens) was etched by HF; Groups 3-7 (36 specimens each) were treated with APPJ, and the relative air humidity (RAH) of the discharge was 22.8%, 43.6%, 59.4%, 75.2%, and 94.0%, respectively. Three LDC blocks in each group were characterized via X-ray photoemission spectroscopy (XPS) analyses, 3 blocks via contact angle measurements, and other 10 blocks via surface roughness measurements. The residual LDC blocks in groups 2-7 were cemented to composite cylinders. Testing the cemented specimens' shear bond strength (SBS) before and after thermocycling (6,500 cycles of 5°C and 55°C) revealed fracture patterns. Data were analyzed by ANOVA (post hoc: Bonferroni) (α = 0.05). Results: After APPJ treatment, the water contact angle values of APPJ treated blocks dropped from 31.37° to 5.66°, while that of HF etched ones dropped to 18.33°. The O/C ratio increased after HF etching or APPJ treatment according to the calculated results, except for the APPJ-treated samples at a RAH of 22.8%. The surface roughness of LDC blocks showed no statistic difference before and after APPJ treatment, but experienced significant difference after HF etching. The O/Si and O/C ratios varied after HF etching or APPJ treatment. No significant difference in SBS values could be found among groups 2-7 before or after artificial aging (p > 0.05). All specimens showed mixed failure patterns. Conclusion: The APPJ treatment method reported in this study is a promising novel strategy for surface modification of the LDC. With acceptable bonding strength, it might be an alternative to HF in LDC-resin cementation.

Effects of Hydrofluoric Acid Concentrations, Commercial Brands, and Adhesive Application on the Bond Strength of a Resin Luting Agent to Lithium Disilicate Glass Ceramic.

To evaluate the surface topography/roughness and bond strength of a resin luting agent to a lithium disilicate glass ceramic after etching with different concentrations of hydrofluoric acid (HF) and commercial brands. For bond strength evaluation, 260 lithium disilicate glass ceramic (EMX) discs were randomly distributed into 13 groups based on concentrations of HF and commercial brands (n=20): 5% and 10%, Lysanda (LY5 and LY10); 5% and 10%, Maquira (MA5 and MA10); 5% and 10%, FGM (FG5 and FG10); 4.8%, Ivoclar Vivadent (IV5); 5% and 10%, PHS do Brasil (PH5 and PH10); 5% and 10%, BM4 (BM5 and BM10); 9%, Ultradent Inc (UL10); and Dentsply (DE10). A further random distribution (n=10) was made based on the application (+) or absence (-) of an adhesive layer. Resin luting agent cylinders (1 mm in diameter) were added on EMX surfaces, light-cured, and stored for 24 hours in deionized water at 37°C. On a universal testing machine (DL 500, EMIC), specimens were submitted to a microshear bond strength test at a crosshead speed of 1 mm/min until failure. A representative etched EMX disc from each group underwent surface topography analysis using field-emission scanning electron microscopy (n=1), and five (n=5) etched EMX discs from each group were tested for surface roughness. Data were statistically analyzed using analysis of variance and Tukey test (α=0.05). A less conditioned and smoother surface was observed for 5% HF compared to 10%. Additionally, commercial brands of HF were shown to affect bond strength. When the adhesive layer was not used (-), a 10% concentration promoted higher bond strengths to EMX. However, when adhesive was applied (+), the concentrations of HF and commercial brands had no effect on bond strength results. A 10% concentration of HF results in higher bond strength than a 5% concentration. If an adhesive layer is applied, neither this distinction nor the influence of commercial brands is observed.

Effect of mouth rinses on the stainability of monolithic lithium disilicate glass-ceramics with different surface treatments: An in vitro study

Mouth rinses have been reported to cause tooth surface discoloration. However, information regarding their effect on the stainability of monolithic glass-ceramics with different surface treatments is lacking. The purpose of this in vitro study was to assess the effect of mouth rinses on the color change of milled and pressed monolithic lithium disilicate glass-ceramics with different surface treatments. Fifty-six Ø12×1.5-mm disk specimens were fabricated using 2 different processing techniques: milling and pressing. Each group was subdivided into 2 subgroups according to surface treatments: glazed and polished. Specimens were then immersed in 2 different types of mouth rinse (n=7): chlorhexidine (CHX) and Listerine (LST). Color parameters were assessed using a digital spectrophotometer. Color difference (ΔE00) was calculated and compared with perceptibility (ΔE00=0.8) and acceptability (ΔE00=1.8) thresholds. The data were analyzed using ANOVA and Tukey post hoc tests (α=.05). The color difference (ΔE00) was significantly affected by the type of processing technique, surface treatment, and mouth rinse (P<.001) and their interaction (P=.008). All ΔE00 values were below the selected clinical acceptability threshold (ΔE00=1.8). Milled groups (ΔE00=1.13) showed greater discoloration than pressed groups (ΔE00=0.86). Glazed specimens (ΔE00=0.70) were more resistant to discoloration than polished specimens (ΔE00=1.28) and immersion in CHX (ΔE00=1.09) led to more discoloration than immersion in LST (ΔE00=0.89). The color of milled and pressed monolithic lithium disilicate glass-ceramics with different surface treatments was affected by using CHX and LST mouth rinses. Glazed lithium disilicate glass-ceramics showed less staining compared with those that were polished. Specimens immersed in CHX showed more discoloration than those immersed in LST.

Clinical outcome of three different types of posterior all-ceramic crowns. A 3-year follow-up of a multicenter, randomized, controlled clinical trial.

To assess and compare the clinical outcomes of three different types of all-ceramic posterior monolithic tooth-supported crowns. A total of 71 patients received 90 all-ceramic crowns randomized to be either high-translucency zirconia (ZC), high-translucency zirconia with a partial buccal veneer (ZC-V), or lithium disilicate glass-ceramic (LDS). All treatments were performed by four general dentists. Choice of material was blinded. Baseline and subsequent annual evaluation were based on modified California Dental Association (CDA) criteria. A questionnaire was used to include patient-reported outcomes and to compare them to the crown quality rating performed by dentists. A total of 66 patients with 84 crowns were examined after 3 years. The survival rate was 98.8%. No crowns fractured during the observation period. One ZC-V crown failed due to loss of retention, and three complications were noted: loss of retention occurred in one ZC crown, and two ZC crowns needed to be endodontically treated. There was no significant difference between the different crowns regarding marginal integrity, surface, or anatomical form. Both patients and examining dentists rated the crowns favorably regarding esthetics, patients more than dentists. Posterior lithium disilicate glass-ceramic crowns and translucent zirconia crowns with or without a partial buccal veneer show excellent and promising clinical outcomes from a short-term perspective. Patients and dentists rate the restorations favorably concerning esthetics and function.

Hydrofluoric acid concentration and etching time affect differently the microstructure and surface properties of pressed lithium disilicate glass ceramics.

To evaluate the effect of different hydrofluoric acid concentrations and etching times on the surface, chemical composition and microstructure of lithium disilicate. Ninety specimens of pressed lithium disilicate (LDS) were obtained (IPS e.max Press, Rosetta SP and LiSi Press). The specimens of each material were divided in two groups according to the hydrofluoric acid concentration: 5% and 10% (n = 15/group), and subdivided according to the etching time: 20, 40 and 60 s (n = 5/group). Crystalline evaluations and chemical composition were performed through x-ray diffraction (XRD) and energy-dispersive x-ray spectroscopy (EDS), respectively. Microstructural analyses were performed by scanning electron microscope (SEM), surface roughness (Ra), and material thickness removal evaluation. Thickness removal and Ra data were analyzed by ANOVA and Tukey test (p < 0.05). XRD demonstrated characteristic peaks of lithium disilicate crystals, lithium phosphate and of a vitreous phase for all materials. EDS identified different compositions and SEM confirmed different surface responses to acid etching protocols. Material and etching time influenced Ra and material thickness removal (p < 0.05). Hydrofluoric acid concentration and etching time affect the surface characteristics of LDS differently. LiSi Press presented higher resistance to hydrofluoric acid etching compared to e.max Press and Rosetta SP. Applying the appropriate etching protocol is pivotal to avoid excessive material removal and to prevent jeopardize the mechanical and optical properties of the material.